Register as an Individual

Membership Commitment Form for Individuals

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Name *

First

Last

Phone Number *

Email *

Do you grant permission to the Leadership Committee to contact you about 100+ Women Who Care Quinte via email? *

YES NO

Mailing address (for charitable donation receipts) *

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City

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Zip Code

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Check the box(es) below to agree to the following statement(s): *

I understand that I am making a commitment to 100+ Women Who Care Quinte to make a quarterly donation of $100, four times per year, which will be given directly to local charities, non-profits and organizations serving the Quinte area. I agree to fulfill my donation commitment even if I did not vote for the charity selected by majority vote. If I am unable to attend a quarterly meeting, I will do one of the following: send an eTransfer, provide my cheque to another member to deliver in my place; or deliver my donation in person to 100+ Women Who Care Quinte c/o Kimberly's DeJa Vu Boutique, in the Sommerville Centre, 6835 Hwy 62 N, Belleville. I give permission to 100+ Women Who Care Quinte to use photos that I am in for web content, advertising, etc.

Do you give permission to have your name posted on the 100+ Women Who Care Quinte website, Facebook Page, Twitter profile, etc.? *

YES NO

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